Cataract

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Cataract  is  clouding  of  the  lens  of  the  eye  which  prevents  clear  vision.  It  may  be  as  a  result  of  ageing  process  or  secondary  to  trauma  or  inflammatory  diseases.  Children  may  be  born  with  cataract or develop cataract in the early ages of life. 

Clinical Presentation 

• Various degrees of vision impairment unilateral or bilateral
• History  of  trauma  with  a  sharp object for traumatic cataract
• History  of  red  eye  for  secondary cataract.
• Glare and haloes around light

Note: 

• Cataract may present in all age groups, blindness due to cataract is reversible
• Treatment is only by surgery
• Early treatment in children is mandatory
• White pupil in children may be a tumor in the eye, late referral may lead to permanent loss of vision, squint, loss of eye or loss of life

Investigations 

• Visual acuity
• Slit Lamp Bimicroscopy
• Refraction depending on the density of cataract
• Dilated Fundoscopy
• B Scan if no fundal view
• A Scan
• Biometry for Intraocular (IOL) calculation

Surgical Treatment 

The only treatment available for Cataract is surgery. There are different cataract surgical procedures  depending  on  the  causes  of  cataract,  age  of  the  patient  and  surgeons’  skills  and  equipment  availability.  

Pharmacological Treatment  Preoperative Treatment 

A: amethocaine hydrochloride 1% Eye drops 

OR 

C: tetracaine 0.5% Eye drops 

AND 

C: tropicamide 1% +phenylephrine 2.5% (FDC) Eye drops 

Alternatively 

C: tropicamide 1% Eye drops 

AND  

A: iodine 2.5 – 5% Eye Drops 

AND  

A: lignocaine hydrochloride with adrenaline 2%, combined with hyaluronidase 1500IU, 5mL, retrobulbar or Subtenon injection stat,  

OR 

A: lignocaine hydrochloride, combined with hyaluronidase 1500IU, 5mL, retrobulbar or  subtenon injection stat,  

Intraoperative Treatment 

A: adrenaline 0.5mL infusion in 500mL compound sodium lactate intracameral in during the surgery      

AND 

C: trypan blue 0.06% injection, 0.4mL intracameral, stat 

AND 

S: sodium hyaluronate 1% Intracameral and topical stat 

AND 

S: acetylcholine chloride 1% Injection, 0.5ml intracameral stat 

AND 

B: dexamethasone phosphate 1.25mg intracameral injection stat 

AND 

A: gentamycin 1.25mg intracameral and subtenon injection stat 

OR 

B: ceftriaxone 5mg intracameral and subtenon injection, stat 

In addition to the above intraoperative medicines, in children and patients with preoperative  ocular inflammatory conditions, use 

S: triamcinolone acetone 20mg injection, Sub tenon, stat 

OR 

D: methylprednisolone 20mg injection, Sub tenon, stat 

Postoperative Treatment 

C:dexamethasone + chloramphenicol 0.1 – 0.5%, 1 -2 Drops in the operated eye, 2hourly for 7days then 4hourly for days 

OR 

C: dexamethasone + gentamicin 0.1 - 0.3%, 1 – 2 Drops in the operated eye, 2hourly for  7days then 4hourly for 7days   

AND 

C: cyclopentolate 1%, 1 – 2 Drops in the operated eye, 12hourly for 14days 

OR 

B: atropine 1%, 1- 2 Drops in the operate eye, 24hourly for 14days 

AND 

C: acetazolamide (PO) 500mg, stat 

AND 

A: paracetamol (PO) 1 gm, 8hourly for 3days 

THEN: 

D: prednisolone 0.5%, 1 – 2 Drops, 6hourly for 4weeks 

Note 

• Atropine is given to patients where excessive inflammation is anticipated such as cataract surgeries in children, traumatic cataract and secondary cataract.
• Children may require longer term and more frequent topical steroids depending on their postoperative response

Referral:  Refer  all  cases  to  eye  surgeon  for  cataract  surgery,  available  at  some  of  the  Districts,  Regional, Zonal and National Hospitals. Children should be referred immediately to a Tertiary Health  Facility with capacity to operate children’s eyes safely.